To War and Back Again

February 21st, 2006 by

The good news from Iraq (OK, there isn’t much) involves the dramatic improvement in battle-related trauma treatment. Soldiers are surviving injuries that in prior wars would have resulted in certain death. So far, over 15,000 soldiers have been injured since the fighting began in March 2003. By the time major military operations have been completed, more than two million soliders will have been deployed in Iraq and Afghanistan. That would project to about 70,000 troops suffering physical injuries.
These wounded soldiers return to the states, go through rehabilitation and then, one hopes, they return to the workplace. When you consider that about 30 percent of the armed forces are citizen soldiers (National Guard and Reservists), you realize that many of these injured soldiers will be returning to the jobs they left behind. Their employers will be confronted with the challenges of “reasonable accommodation” – trying to adapt job functions to the capabilities of their returning workers.
As challenging as this accommodation process is likely to be, it may prove far easier than dealing with the mental health issues of returning soldiers.
The Stress of War
There’s something about people trying to kill you 24/7 that gives rise to inordinate stress. This is stress of a level that few people outside of the military – or a war zone – ever experience. In a compelling article (PDF) written by Robert Hartwig for the Insurance Information Institute, we learn that nearly 30 percent of returning military personnel suffer from at least one type of mental health problem, including depression, anxiety and/or post-traumatic stress syndrome (PTSD).
Here we have a confluence of issues that bode poorly for these returning heroes. We seem to expect that people thrown into war will simply pack up their gear, change into civilian clothes and go about their business. For some, that may prove possible. But for others, the transition will be excrutiating.
Given this country’s ambivalence about mental health treatment, it’s not surprising to find that even soldiers with stress symptoms often resist treatment. Hartwig quotes a study in the New England Journal of Medicine that found a reluctance to use mental health services even among soldiers who met screening criteria for major depression, anxiety or PTSD:
– only 78 percent acknowledged a problem
– just 43 percent indicated an interested in receiving help
– only 40 percent had received help within the past year (and just 27 percent received help from a mental health professional)
The respondants cited a number of reasons for not seeking help, including the belief that they would be perceived as weak (65 percent), embarassment (41 percent) and difficulty getting time off for treatment (55 percent). (As for that last problem, employers would likely be obligated to provide release time for counseling under the Americans with Disabilities Act.) But tellingly, 38 percent indicated that they did not trust mental health professionals, while 25 percent believed that mental health care doesn’t work at all!
There are at least three significant themes here: First, we live in a culture that continues to stigmatize mental illness. Second, the mental health profession has done a poor job of explaining itself to the general public. And third, the employers of these mentally stressed (and untreated) soldiers will be confronted with a host of problems when these former workers return from their battlefield commitments.
Hartwig points out that returning veterans with physical or mental impairments are entitled to lifetime benefits from the Veterans Administration (assuming, of course, that VA services are adequately funded). The VA also operates a Readjustment and Counseling Service to ease the transition of veterans returning to civilian life. Insurance claims adjusters would do well to take note of these resources!
Business as Unusual
As civilian soldiers return to their jobs in the months and years ahead, the workplace will be subject to new stresses and strains. Having sacrificed so much through their military service, returning workers may find themselves unable to handle the jobs that had once been routine. Employers will have to work diligently and creatively to ease the transition back to productive employment. If nothing else, employers should encourage access to counseling services for stressed-out employees (on company time, if needed).
If employers drop the ball by ignoring the transition problems of their returning workers, there could be some very big problems indeed: disruption and violence, lower productivity, unanticipated injuries and increased costs for workers compensation, to mention just a few. Many of the civilian soldiers returning to the workplace will face challenges unlike anything they experienced prior to going off to war. Employers take heed: this cannot be managed under the heading of “business as usual.”
Special thanks to our colleague Joe Paduda at Managed Care Matters for pointing out this important article.